tbuckley/cabot-search huggingface dataset:
Abstract 15439: Longitudinal Assessment of Racial Differences in Exercise Capacity After Breast Cancer Treatment: WF-97415
Authors: Kerryn Reding, Nathaniel S O'Connell, Warren Szewczyk, Richard K Cheng, Johnny Nguyen, Amy C Ladd, Jennifer H Jordan, Alexander R Lucas, Vanessa B Sheppard, Yaorong Ge, Fadi N Salloum, Youngdeok Kim, Edward J Lesnefsky, Robert L Franco, Giselle C Melendez, Arnethea L Sutton, Ralph Dagostino, Kathryn E Weaver, Glenn J Lesser, William G Hundley
Journal: Circulation (2022)

Introduction: Breast cancer (BC) treatment toxicity contributes to elevated rates of cardiovascular morbidities, such as reduced exercise capacity, a risk factor for long-term cardiovascular disease (CVD) and mortality. Past studies have shown that Black women experience greater cardiotoxicity after BC treatment than white women. No studies have investigated racial differences in exercise capacity. The lack of longitudinal data leaves uncertainty as to whether greater declines in exercise capacity are experienced by Black BC survivors. Methods: This cohort was comprised of 236 women with stage I-III BC (80% white; 20% Black) and 130 cancer-free controls in the UPBEAT (NCT02791581) and DETECT (NCT01719562) studies. Submaximal exercise capacity was obtained via 6-Minute Walk Distance (6MWD, meters [m]) at baseline (pre-treatment) and 3 months. Linear regression was used to examine associations of race with baseline 6MWD and changes in 6MWD. Results: Mean age [SD] of BC survivors was 55.7 [10.9] years. Mean [SD] total meters walked pre-treatment was lower in Black women with BC (423 m [81.0]) than white women with BC (475 m [87.7]; p=0.01), and lower than Black women without BC (471 m [76.9]; p=0.07). Black BC survivors experienced a greater mean decline from baseline to 3-months in 6MWD (30 m [68.5]) than white BC survivors (21.7 m [86.6]; Table 1; p=0.02) or Black women without BC (9.2 m [67.3]; p=0.001), translating to a mean difference of 60 m between Black and white BC survivors during BC treatment. Conclusions: This is the first study to suggest racial differences in submaximal exercise capacity during BC treatment. Black BC survivors experienced a greater reduction in exercise capacity than white BC survivors after cancer treatment as early as 3-months post-diagnosis. This clinically-meaningful difference in exercise capacity warrants further investigation, particularly to determine interventions to reverse the loss of exercise capacity.
Abstract 14649: Low Plasma Transthyretin is Associated With All-Cause and Cardiovascular Mortality in the General Population
Authors: Mette Christoffersen, Anders M Greve, Louise S Hornstrup, Borge G Nordestgaard, Anne Tybjaerg-hansen
Journal: Circulation (2022)

Introduction: Transthyretin tetramer destabilization is the rate-limiting step in transthyretin cardiac amyloidosis, which is an underrecognized contributor to heart failure and mortality in older adults. Evidence suggests that low plasma transthyretin is an in vivo marker of transthyretin tetramer instability. Hypothesis: We tested the hypothesis that low plasma transthyretin genetically and observationally associates with all-cause and cardiovascular mortality. Methods: We genotyped 102,204 individuals and measured plasma transthyretin concentrations in 19,619 individuals from two studies of the Danish general population, the Copenhagen City Heart Study and the Copenhagen General Population Study. We first tested whether genetic variants in TTR , which associated with increasing transthyretin tetramer instability, also associated with lower plasma transthyretin and higher risk of all-cause and cardiovascular mortality. Second, we tested whether low plasma transthyretin associated with higher risk of all-cause and cardiovascular mortality. Results: Compared to p.T139M, a well-known transthyretin stabilizing mutation, TTR genotype was associated with stepwise lower transthyretin concentrations of -20% for wild-type and -30% for heterozygotes for “Other mutations” (p.V142I, p.H110N, p.D119N). The corresponding hazard ratios (HR) for all-cause and cardiovascular mortality were 1.37(95% CI: 1.06-1.77) and 1.63(0.92-2.89) in wild-types, and 1.66(0.95-2.88) and 2.23(0.78-6.34) in carriers of “Other mutations”, respectively (Figure). In adjusted observational analysis individuals with plasma transthyretin ≤5 th percentile (&lt;19.1 mg/dL) versus 6-95 th percentile (reference) had HRs of 1.39(1.17-1.64) and 1.66(1.17-2.38) for all-cause and cardiovascular mortality. Conclusions: Genetically and observationally low transthyretin concentrations are associated with higher risk of all-cause and cardiovascular mortality.
Abstract 241: Comparison Of A Phone-based Business AED Survey Canvas, 911-Dispatch AED Inventory, And State-Mandated AED Registry In Forsyth County, NC
Authors: Jerishma Patel, Faraan Rahim, Sreekanth Yellanki, Hanul Choi, Denise Simmons, Patrick H Pun, Konstantin Krychtiuk, Christopher Granger, Darrell Nelson, Tyson Clark, Lisa Monk, Daniel B Mark, Monique A Starks
Journal: Circulation (2022)

Introduction: In North Carolina (NC), 911-dispatch centers are accelerating treatment to OHCA by notifying bystanders of nearby public AEDs. This system depends on a comprehensive registry of AED locations. State law requires registration of AEDs with the NC Office of EMS (NC OEMS), but adherence to this legislation is unknown. The purpose of this study was to determine the registration status of public AEDs in a large county in NC. Methods: Using structured phone surveys, we determined the AED status and information for businesses in Forsyth County, NC. Using a national business database, we identified all registered large businesses (&gt;20 employees) and select small businesses (1-19 employees) most likely to have an AED: healthcare, government, childcare, educational, and religious organizations. In addition, AED lists were elicited from large organizations (e.g non-hospital health clinics, universities, and county government) (n=293 AEDs), NC OEMS (n=336), and 911-dispatch center (n=73). Results: Between 1/2/22-5/7/22, we contacted 1,702 businesses (response rate =79.1%). Of these, 411 (30.5%) businesses reported &gt;= 1 AEDs. Additionally, 106 unique AED locations were identified from large organizations; 22 from the 911-dispatch; and 34 from the NC OEMS registry. The final AED list contained 963 AEDs at 573 unique locations (Table). Identified AEDs were most frequently located at health clinics, schools, colleges, offices, industrial facilities, and churches. A majority of AEDs (65.1% [627/963]) were not previously registered in the NC OEMS AED registry. Few business AEDs (11.8% [114/963]) were listed in the county dispatch agency’s geolocation software system. Conclusion: Most businesses and organizations in our survey canvas had AEDs that were unregistered in a state-mandated AED registry. Structured strategies to increase reporting of publicly available AEDs to NC OEMS and transfer of that information to county 911-dispatch systems are needed.
Abstract 14567: Safety of Concomitant Percutaneous Left Atrial Appendage Occlusion Among Patients Undergoing Catheter Ablation for Atrial Fibrillation
Authors: Chisa Asahina, Reina Tonegawa-Kuji, Toshiki Kuno, michikazu nakai, Koshiro Kanaoka, Yoshitaka Iwanaga, Kengo Kusano
Journal: Circulation (2022)

Background: The safety of concomitant percutaneous left atrial appendage occlusion procedure (LAAO) among patients undergoing catheter ablation (CA) for atrial fibrillation (AF) is unclear. This study aimed to evaluate the association between concomitant LAAO vs non-receipt LAAO with the risk of in-hospital complications and 30-day all-cause readmission among patients undergoing CA for AF. Methods: We performed a retrospective study using the Nationwide Readmission Database of the United States. The primary outcome was the in-hospital composite complications, which was defined as a composite of death, tamponade, hematoma, pneumothorax, and blood transfusion. The secondary outcome was the 30-day all-cause readmission. We performed a 1:10 propensity score (PS) matching analysis to compare the safety of performing and not performing LAAO on the same day of CA for AF. Logistic regression analysis was performed to evaluate the association between performing LAAO and the endpoints in the PS-matched cohort. Results: Among 25,834 patients (median age 70 years [62-78], 45% female) who underwent CA for AF between 2017 and 2019, 146 patients (0.6%) underwent LAAO on the same day. After the PS matching, a total of 1,515 patients (145 in the LAAO group and 1,370 in the non-LAAO group) were included in the comparative analysis. Concomitant LAAO procedure was not associated with higher risk of in-hospital complications (LAAO vs. non-LAAO; 10% vs. 7.9%; odds ratio [OR]; 1.35, 95% confidence interval [CI]; 0.76-2.38) and 30-day all-cause readmission following discharge (10% vs. 14%; OR; 0.71, 95% CI; 0.41-1.24). Conclusions: There was no significant difference in the in-hospital complications and 30-day all-cause readmission rates following LAAO and CA for AF compared to that of those who underwent CA for AF without LAAO.
Abstract 14457: Cardiac MRI Results Following RFA and Cryoballoon Ablation: DECAAF II Subanalysis
Authors: Daniel Nelson, Aneesh Dhore, Mario Mekhael, Charbel Noujaim, Abdel Hadi El Hajjar, Nassir Marrouche
Journal: Circulation (2022)

Introduction: Radiofrequency (RFA) and cryoballon ablation are standard approaches for rhythm control of atrial fibrillation. Both strategies involve scar formation of the left atrial tissue. To date there have been no studies using post ablation cardiac magnetic resonance imaging (MRI) to assess residual fibrosis and scar created by standard radiofrequency and cryoballoon ablation. Methods: The current study is a sub analysis of the control group of the Delayed-Enhancement MRI Determinant of Successful Catheter Ablation of Atrial Fibrillation trial (DECAAF II). This was a multicenter, randomized, controlled, single blindedtrial that evaluated atrial arrhythmia recurrence (AAR) between PVI alone and PVI plus fibrosis guided ablation. Baseline MRI and 3-month post ablation MRI were obtained to assess lesion and scar formation. Results: Of the 843 patients randomized in the trial, 428 patients were in the control arm that received standard PVI alone. Of those 428 patients, 367 patients (85.7%) underwent RFA and 61 (14.3%) underwent cryoballoon ablation. Average procedure duration was 147 minutes for RFA and 107 minutes for cryoballoon (p = 0.001). The rate of AAR at 451 days was 42.0% in the RFA group and 45.9% in the cryoballoon group (p = 0.66). At the 3-month post MRI the RFA arm had significantly more left atrial scar formation compared to cryoballoon arm (8.8% vs. 6.4%, p = 0.001). Also, the RFA arm had more covered fibrosis (3.6% vs. 2.9%, p = 0.02) and less non-covered fibrosis (14.9% vs. 17.2%, p = 0.05) compared to the cryoballoon arm. The amount of scar formation did not predict AAR (p = 0.07). Conclusions: In this subanalysis of the DECAAF II trial, there was no significant difference in the rate of AAR between RFA and cryoballoon ablation. However, RFA caused significantly more left atrial scar compared to cryoballoon ablation on 3-month post MRI.
Abstract 15106: Impaired Regional Strain by Cardiovascular Magnetic Resonance Feature-Tracking Predicts Low Sensing Value After Cardiac Defibrillator Implantation in Patients With Arrhythmogenic Cardiomyopathy
Authors: Zhongli Chen, Yanyan Song, Liang Chen, Shihua Zhao, Keping Chen
Journal: Circulation (2022)

Introduction: Inadequate ventricular sensing at implantable cardiac defibrillator (ICD) implantation in patients with arrhythmogenic cardiomyopathy (ACM) is troubling and might cause inappropriate ICD interventions and complications. We aimed to evaluate the value of ventricular mechanics features in predicting low sensing value by emerging cardiovascular magnetic resonance-feature tracking (CMR-FT) in ACM patients. Hypothesis: CMR-FT characteristics prior to ICD implantation might assist in predicting low R wave amplitude. Methods: We retrospectively enrolled ACM patients receiving CMR examinations prior to ICD implantation at our center from January 2011 to July 2021. The strain parameters of LV and RV were analyzed by CMR-FT. The R wave amplitude (RWA) was obtained within 24 hours of completion of the ICD implantation and its association with CMR strain parameters was analyzed. Results: We enrolled 83 ACM patients with a median RWA of 8.0 mV (Interquartile range IQR:5.4-12.1 mV) and impedance within the normal range. 18 (21.7%) patients were found with low RWA (&lt;5mV) despite attempts in over 5 positions. RV strain parameters including RV global longitudinal, circumferential and radial strain rather than LV strain parameters correlated significantly with RWA (Spearman’s correlation coefficients: GLS: -0.35, GCS: -0.58, GRS: 0.59, all P&lt;0.01). RVGRS and RVGCS were found not only associated with RWA after adjusting for clinical cofounders (coefficients: RVGCS: -0.53, RVGRS:0.32, p&lt;0.01) but also valuable in predicting low RWA (areas under the curve: 0.76 and 0.73 respectively; sensitivity: both 0.72, specificity: both 0.71). Conclusions: Low sensing of ICD lead in ACM patients was associated with impaired RV mechanics. RVGCS and RVGRS by CMR-FT were valuable parameters for predicting low RWA and might assist operation planning.
Abstract 14606: Accurate Detection of Acute Psychological Stress Events Using Single Lead ECG Data
Authors: Adrian Deery, Mark Lilburn, Stacey McKenna, Matthew Fitzpatrick, Holly Easlea, Rebecca Funston, Adrian Condon, Andrew R Mitchell
Journal: Circulation (2022)

Introduction: Stress has been linked to numerous health conditions, including heart disease, diabetes, and mental health issues. By monitoring changes in physiological signals, such as heart rate (HR) and heart rate variability (HRV), wearable biosensing technology allows acute stress to be non-invasively tracked over long periods, providing valuable insights for preventative healthcare. Methods: This two-phase study comprised several protocols designed to induce varying levels of psychological stress in participants (N=39). HR and HRV metrics, derived from electrocardiogram (ECG) data collected throughout the protocol on the single lead HeartKey ® Chest Module, were used by the HeartKey Stress algorithm to generate a relative stress score (0-100), which was validated against two clinically recognized methodologies for assessing patient stress: i) state-trait anxiety index (STAI), a questionnaire that subjectively measured the individual’s perceptual stress after each stage of the protocol, and ii) electrodermal activity (EDA), which continuously monitored conductive changes at the skin’s surface with an Empatica ® E4 wrist wearable. Results: Over both phases, participant STAI scores increased significantly during stress protocols (49.9 ± 23.3) relative to the baseline (30.0 ± 10.0). Mean HR showed a similar significant increase ( p &lt; 0.001), and HRV gradually decreased throughout the testing protocol. HeartKey Stress scores derived from HR and HRV data showed a strong correlation to STAI scores. Furthermore, the HeartKey Stress trend closely replicated that of the EDA data. Conclusions: HeartKey Stress algorithm consistently generated accurate and reliable stress scores in response to events of induced, acute psychological stress. The results suggest that the algorithm has potential utility for continuous clinical monitoring of patients with stress-related illnesses.
Abstract 14484: Shockwave Lithotripsy as a Non Surgical Modality for Calcified Carotid Stenosis
Authors: Yash K Varma, Aatrey Dixit, Nihar Jena, Kirit Patel
Journal: Circulation (2022)

An 80-year-old gentleman with significant bilateral carotid artery stenosis and previous right carotid endarterectomy underwent a CT Angiogram of the Head and Neck due to multiple episodes of syncope. The study revealed heavily calcified atherosclerotic disease at the left carotid bulb and bifurcation, causing high-grade luminal stenosis of 80 to 82% at the origin of the internal carotid artery. Hence, a decision was made to obtain a cerebral angiogram. Aortic arch angiogram revealed a type III arch, following which a cerebral catheter wire was engaged in the left carotid artery. A selective angiogram showed 80% calcified stenosis at the level of bifurcation, with the left external carotid artery being 100% occluded. Given the heavily calcified lesion, supra core guidewire was crossed across the lesion, followed by advancement of protection device into the distal segment of the left internal carotid artery. Balloon angioplasty was performed twice from the ostial to the proximal segment of the left internal carotid artery. An attempt was made to place a stent without any success. Subsequently, a decision was made to proceed with shockwave lithoplasty. We inserted a transvenous pacemaker with a backup rate of 40 bpm. A Shockwave catheter was inserted and shockwaves were delivered with multiple inflation techniques at 4 atmospheric pressure for 15 seconds each. Periodic neuro assessments were normal. This was followed by the placement of stents in the distal left common carotid and ostial to proximal left internal carotid artery reducing the calcified 80% stenosed lesion to 10% with excellent angiographic results. Subsequently, the filter and the catheter were removed and the femoral artery access site was secured. The patient tolerated the procedure very well without any immediate or delayed complications. The intracerebral vasculature remained intact as confirmed by a cerebral angiogram. TVP was removed and the patient was discharged in a stable condition after 2 days. Hence, Shockwave lithotripsy can be successfully used for critical carotid artery stenosis in patients that pose a high surgical risk. It helps soften the lesion for better dilatation of the vessel and achieve improved luminal gain for appropriate stent expansion.
Abstract 14742: Driveline Infections Are Associated With Increased Hospitalizations Amongst Heartmate III Recipients
Authors: Jason Feinman, Alvin Mathew, Sophia Golec, Aarti Rao, Julie Roldan, Anuradha Lala, Noah Moss, Aditya Parikh
Journal: Circulation (2022)

Introduction: The Heartmate III (Abbott, Chicago) is the only currently available durable left ventricular assist device (LVAD). Driveline infections (DLI) are a potential complication of durable mechanical circulatory support (MCS). We sought to analyze the impact of driveline infections on post-implantation outcomes. Methods: Consecutive patients who underwent implantation of a Heartmate III LVAD at our institution were analyzed. Patients were excluded if the device was placed as part of an exchange for another durable MCS device. Patients were followed until transplant, device exchange, death, or end of follow up. The primary outcome was the difference in number of hospitalizations and days hospitalized between patients with driveline infections compared to those without. Results: 130 patients (average age 59 years, 71% male) underwent implantation of a Heartmate III LVAD between September 2015 and March 2021. Over an average follow up of 23 months, 51 patients developed a documented DLI. The average time to DLI was 336 days. 90 percent of the initial DLI were caused by single organisms and 53 percent of these organisms were gram-positive. The number of total hospitalizations (2.6 vs. 5.9, p=0.00001) and total days hospitalized (28.8 vs. 62.7, p=0.0002) were increased in patients with DLI. Patients with DLI spent an average of 27 days hospitalized for reasons related to their DLI. 23 percent of patients with DLI required extended treatment with IV antibiotics for their first infection. 31 percent of patients with DLI were later transitioned from oral to extended treatment with intravenous antibiotics. 16 patients with DLI required debridement and 5 ultimately required device exchange. Conclusions: Despite improvement in device design and hemocompatibility, driveline infections remain a common source of morbidity for patients supported by Heartmate 3 LVAD and are associated with increased hospitalizations and hospitalization days. The potential morbidity should be discussed with patients prior to implantation and diligent care must be taken post-implantation to reduce the impact of this common complication.
Abstract 14535: Association Between Lower Extremity Revascularization Reinterventions and Treating Facility on Limb Preservation
Authors: Olamide Alabi, Yazan Duwayri, Xinyan Zheng, Jialin Mao, NADER MASSARWEH
Journal: Circulation (2022)

Introduction: Lower extremity revascularization (LER) improves quality of life and limb preservation rates. However, LER is complicated by the frequent need for short-term reintervention (re-LER). It is unclear if re-LER at a facility that did not perform the initial revascularization is associated with subsequent amputation. Hypothesis: Re-LER at a non-index procedural site is associated with 90-day major amputation. Methods: This was a national cohort study of older adults who underwent endovascular LER for PAD with subsequent re-LER (January 1, 2010 - December 31, 2018) in the Vascular Quality Initiative dataset linked to CMS claims and American Hospital Association facility-level data. We excluded acute limb ischemia and aneurysm procedural indications. The primary outcome was 90-day amputation. The primary exposure was site of first re-LER (same or different than index site). Multivariable logistic regression was used to determine the association between patient and facility characteristics and the likelihood of 90-day amputation. Results: Among 4,473 patients, 60.6% were male and 82.5% were White. One-fifth of patients had their re-LER at a non-index procedural site. Chronic limb threatening ischemia (CLTI) was the operative indication in 52.9%, 44.2% were on the femoropopliteal segment, and 64.8% of index LER procedures were completed in the outpatient setting. Comparing those who had re-LER at a non-index versus index procedural site, there were no differences in age or sex. However, a higher proportion of Black patients had their first re-LER at a non-index site (16.0% vs 13.7%, p=0.01). After adjusting for patient characteristics, re-LER at a non-index facility was associated with a 34% increase in the odds of amputation (odds ratio [OR] 1.34 [95% CI 1.02-1.75]). Additionally, non-White race was also associated with increased odds of amputation (OR 1.40 [95% CI 1.06-1.84]). After adjusting for facility characteristics, these differences were no longer significant. Conclusions: Disease-specific factors appear to be associated with the likelihood of amputation after re-LER while sociodemographic and facility-level factors do not. Quality improvement efforts should focus on early identification and management of patients with PAD.